| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,038 |
1,006 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,323 |
1,279 |
$33K |
| D0240 |
|
1,336 |
671 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
295 |
281 |
$23K |
| D0272 |
Bitewings - two radiographic images |
945 |
921 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
959 |
943 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
263 |
148 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
217 |
129 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
184 |
181 |
$6K |
| D1120 |
Prophylaxis - child |
163 |
158 |
$5K |
| D2140 |
|
75 |
37 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
210 |
195 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
104 |
87 |
$2K |
| D2160 |
|
18 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$376.20 |